Prognostic Factors Of Acute Diquat Poisoning

BackgroundSince paraquat was banned,diquat as an alternative herbicide has played an important role in the pesticide market,with a sharp increase in market sales and a gradual increase in the use of diquat in agricultural production.With this,the cases of diquat poisoning have increased year by year.At present,there is no specific antidote for diquat poisoning,and the mortality rate after poisoning is very high.At present,there is no clear conclusion on the prognostic factors of patients with diquat poisoning.ObjectiveBy analyzing the characteristics of demographic data,poisoning related factors,clinical laboratory tests,scores and survival outcomes of patients with acute oral diquat poisoning,this study comprehensively analyzed the prognostic factors of patients with acute oral diquat poisoning,and tried to construct a risk prediction model consistent with acute oral diquat poisoning,so as to provide reference for clinical practice.The purpose of this study is to provide information for the clinical treatment and evaluation of acute diquat poisoning,reduce the mortality and alleviate the social harm.MethodsA total of 291 patients with diquat poisoning in the Emergency department of a large ClassⅢ Grade A hospital in Jinan,Shandong Province from July 30,2021 to July 29,2022 were enrolled.Their demographic data,poisoning related factors,clinical laboratory examination,and scores were collected.Count data were expressed as frequency and percentage,and comparison between groups was analyzed by chi-square test.Measurement data conforming to normal distribution were expressed as mean±standard deviation and compared by independent sample t test.Non-normal distribution was expressed as median,and non-parametric test(Mann-Whitney U test)was used for comparison.At the same time,the correlation analysis of significant variables was performed,and the independent variables were sorted out and screened according to the area under the ROC curve and significance.The significant variables were included in the binary multivariate logistic regression analysis.A statistical difference of P<0.05 was considered.The significant indicators in multivariate logistic regression analysis were included in the receiver operating characteristic curve(ROC)to determine the indicators with the best predictive ability.At the same time,the Logistic regression equation was constructed to test the predictive efficiency of the equation.All data in this study were analyzed by SPSS 27.0 statistical software,and the test level was α=0.05.Results1.Demographic data:the survival outcome of patients with diquat poisoning was statistically different in terms of age,BMI,population type,marital status,and family number(P<0.05),but there was no significant difference in occupation,education level and native place(P>0.05).2.Poisoning related factors:The survival outcome of patients with diquat poisoning is related to urine concentration,disease classification,drinking history,whether to indwelling gastric tube,whether to use antibiotics,whether to be in coma,whether to have normal blood pressure,whether to have gastric lavage,the amount of hormone,the way of admission transportation,the way of admission,clinical manifestations,whether to have anuria,whether to have nervous system symptoms,oxygen therapy,whether to have perfusion,the time of first symptom appearance,and the time of treatment There were significant differences in P,R and SpO2 between the two groups(P<0.05).There were no significant differences in the address of onset,vomiting before treatment,smoking history,past history,allergy history,family history,whether the first time of poisoning,whether the hospital was the first time of treatment,whether the whole gastrointestinal decontamination,the first symptom,whether oral damage,the time from gastric lavage to ingestion,and T(P>0.05).3.Laboratory examination:(1)the results of blood routine analysis showed that there were statistically significant differences in the survival outcomes of patients with acute diquat poisoning in terms of WBC,NEU%,LYM%,NEU#,LYM#,RBC,and HGB(P<0.05),but there was no significant difference in PLT(P>0.05).(2)The results of coagulation related index analysis showed that there were statistically significant differences in the survival outcomes of patients with acute diquat poisoning in PTS,PT-INR,TT-S,TT-R,D-Di,and FDP(P<0.05),but there was no significant difference in APTT-S,APTT-INR and FIB(P>0.05).(3)The analysis results of liver function related indicators showed that the survival outcome of patients with acute diquat poisoning was statistically significant in ALT,AST,yGT,and TBIL(P<0.05),but there was no significant difference in AKP,BC,BU,TP,ALB(P>0.05).(4)The results of renal function index analysis showed that the survival outcome of patients with acute diquat poisoning was statistically different in BUN and Cr(P<0.001).(5)The results of cardiac-related index analysis showed that there were statistically significant differences in the survival outcome of patients with acute diquat poisoning in CK,CK-MB,CTNI,BNP,MYO,and LDH(P<0.001).(6)The results of electrolyte index analysis showed that the survival outcome of patients with acute diquat poisoning was statistically different in GLU,Cl and CO2(P<0.05),but there was no significant difference in K,Na,Ca,P,Mg(P>0.05).(7)The survival outcome of patients with acute diquat poisoning was statistically different in AMY and LIP(P<0.001).(8)The results of urine routine analysis showed that there was a statistically significant difference in the survival outcome of patients with acute diquat poisoning in urinary RBC(P<0.05),but there was no significant difference in urine WBC and urine PRO(P>0.05).(9)The results of arterial blood gas analysis showed that there were statistically significant differences in the survival outcome of patients with acute diquat poisoning in Lac,pH and BE(P<0.001),but there was no significant difference in pO2,pCO2 and SO2%(P>0.05).(10)The results of other indicators analysis showed that the survival outcome of patients with acute diquat poisoning was statistically significant in terms of blood concentration(P<0.001),but there was no significant difference in cholinesterase,infectious diseases,and fecal occult blood(P>0.05).4.Scores:the survival outcome of patients with acute diquat poisoning was statistically significant in SIDP,SIRS score,SOFA score,APACHE Ⅱ score(P<0.001).5.The results of binary multivariate logistic regression analysis of acute diquat po isoning showed that the prognosis of patients with acute diquat poisoning was statistic ally significant in terms of whether there were neurological symptoms(B=3.369,P=0.001),SOFA score(B=0.416,P=0.018),blood concentration(B=1.068,P=0.010),which were independent risk factors for the prognosis of acute diquat poisoning and positively corr elated with the outcome.6.The regression equation Logit(P)=-5.334+3.369× presence of neurological symptoms(yes)+0.416×SOFA score+1.068x blood concentration.Internal validation of the regression model,ROC curve analysis results showed that:The AUC of ROC was 0.750,S.E.=0.080,P=0.003,95%CI was 0.593～0.907,the sensitivity was 69.20%,the specificity was 81.00%,the accuracy was 50.20%,and the Cut-off value was 0.922,indicating that the prediction accuracy of the model was good.Binary logistic regression analysis showed that the equation P<0.001,indicating that the entire equation constructed was statistically significant.The prediction accuracy of the model was 93.40%,the-2 log-likelihood value was 84.072,and the Nagelkerke R2 value was 0.150.Hosmer-Lemeshow goodness of fit test results showed that χ2=8.674,P=0.193,indicating that the observed data were well fitted to the regression model.Conclusions1.The independent risk factors of acute diquat poisoning are neurological symptoms,SOFA score and blood concentration.When diquat poisoning patients have neurological symptoms,SOFA score>3.50 points and diquat blood concentration>0.72μg/ml indicates poor prognosis.2.The established risk prediction model of acute diquat poisoning has a good predictive ability,which is helpful to evaluate the prognosis of acute oral diquat poisoning and provide theoretical basis and certain clinical reference value for the prognosis of acute oral diquat poisoning.